I'm Tired Of These Ungrateful Hurricane Victims

[Jean O'Boyle]

Don't know. I don't remember 1000 people dying so either you are
exaggerating
or the media didn't do its job.

No exaggeration, read below:


http://www.cdc.gov/mmwr/preview/mmwrhtml/00038443.htm

http://www.press.uchicago.edu/Misc/Chicago/443213in.html

http://thomasgalvin.blogspot.com/2005/09/forgotten-national-tragedy-bill.html

http://www.northmiami.us/project/wikipedia/index.php/Chicago_Heat_Wave_of_1995

 

[Nuck 'n Futz]

No exaggeration, read below:


http://www.cdc.gov/mmwr/preview/mmwrhtml/00038443.htm

http://www.press.uchicago.edu/Misc/Chicago/443213in.html

http://thomasgalvin.blogspot.com/2005/09/forgotten-national-tragedy-bill.html

http://www.northmiami.us/project/wikipedia/index.php/Chicago_Heat_Wave_of_1995

Which then begs the question: why DIDN'T the "media do its job"? What kind
of reporting would there have been if that happened while Bush was in
office? Might the race issue been raised (again)?

 

[Kurt Ullman]

Just so it is on the record. The 10,000 body bags in NOLA with
the Mayor saying their could be a need for more has turned into less
than 1,000 for the entire state. There were no bodies in the freezer
at the Dome or Convention Center and a grand total of less than 10
bodies were found between the two (two were murders with one,
according to the coroner, most likely dumped at the Dome sometime
later.. There are no indications that any actually saw the
rape/murder of a child and no body has been found. An investigation
by Coast Guard and military authorities have been unable to turn up
ANY chopper pilot that was actually shot at.
The mayor said that even though it passed all this on, the
ensuing hooha wasn't his fault since it coulda been true.

 

[Jean O'Boyle]

Which then begs the question: why DIDN'T the "media do its job"? What
kind of reporting would there have been if that happened while Bush was in
office? Might the race issue been raised (again)?

What party was in power in city and federal office at the time of the 1995
Chicago incident? Just what does that tell you about the media and its
*unbiased* reporting? There lies your answer. The people who died in the
Chicago 106 degree heat were the poor and the elderly...

 

[David]

He did a fine job. The federal gov;t has no obligation to cover a
states responsibility. The hurricane did little. It was the broken
levees- a state and local responsibility that did most damage.

Levees, dikes and flood walls on any navigable waterway are the Corps of
Engineers responsibilty, therefore federal.

David

 

[tr2267]

At least the racists folks are solidly behind Bush.

 

[tr2267]

OK - then prove that Clinton got more aid to Florida faster than Bush
did to Lousiana (even though the transportation infrastructure was in
MUCH better shape in Florida). I lived through that one, BTW, and can
tell you that the feds did better after Katrina than Andrew, despite
your protestations to the contrary.

With hurricane Andrew were there 100,000 American citizens trapped in a major
city for 4 days without food, water, or law enforcement? Obviously not. Were
there 1,000,000 American refugees who lost their homes (and jobs, etc)
overnight for several months to several years? Obviously not. For Hiroshima
scale disasters like New Orleans no competent President who would have done
what Bush did: give a speech about Iraq because he completely failed to
understand the gravity of the situation. Bill Clinton, Jimmy Carter, LBJ, JFK,
(or any good President) would all have closely managed or micromanaged the
situation, understood the big picture, stayed on top of the specific details,
and personally asked the refugees (including the ones in other states) what
they needed, etc.

And by the way Bush has _already_ _admitted_ he screwed up weeks ago. That
was a huge admission for him because Bush had never ever admitted a mistake
before, not even in the chain of disasters in Iraq.

 

[tr2267]

Where DO you get your news?

In Texas there were local newspaper stories in Bush's first years about
formerly middle class people and families who lost everything and had to check
into homeless shelters. The official unemployment figures are nearly worthless
because they simply don't count lots of folks. BTW the number of Americans who
lost their health insurance increased from 40 to 45 million on Bush's watch.
But nobody should be surprised that Bush doesn't care about such things as
health insurance since Texas (the state Bush was governor of for 8 years) has
by far the highest percentage and number of uninsured people in the country.

 

[Carl 1 Lucky Texan]

In Texas there were local newspaper stories in Bush's first years about
formerly middle class people and families who lost everything and had to check
into homeless shelters. The official unemployment figures are nearly worthless
because they simply don't count lots of folks. BTW the number of Americans who
lost their health insurance increased from 40 to 45 million on Bush's watch.
But nobody should be surprised that Bush doesn't care about such things as
health insurance since Texas (the state Bush was governor of for 8 years) has
by far the highest percentage and number of uninsured people in the country.

Lots of people seem to confuse lack of health INSURANCE with lack of
access to health CARE. Between private charities, special programs of
pharmaceutical compnies, free private clinics, free public clinics,
county hospitals, 'mandatory' ER admittance, Medicaid, and assistance
from family and friends, Rare indeed is the individual that cannot get
medical care in the US if the want it. Does it happen? no doubt - but
there are many worse places to live.

Carl

 

[Mark Hickey]

Lots of people seem to confuse lack of health INSURANCE with lack of
access to health CARE. Between private charities, special programs of
pharmaceutical compnies, free private clinics, free public clinics,
county hospitals, 'mandatory' ER admittance, Medicaid, and assistance
from family and friends, Rare indeed is the individual that cannot get
medical care in the US if the want it. Does it happen? no doubt - but
there are many worse places to live.

The statistics also contain a lot of people who OPT OUT of their
available health care plans. They have access, but just don't want to
pay the partial premiums and figure they won't get sick. Risky, but
for many a good bet (statistically if not realistically). But to
those arguing for national health care, they're identical to those who
truly don't have access to health insurance.

Mark Hickey
Habanero Cycles
http://www.habcycles.com
Home of the $795 ti frame

 

[bigjim]

If you work you get insurance. Even the sweatshop I was an overseer at
offered rudimentary health care. If you drop out of school, get
knocked up and follow the lead of rap music, you will have no job and
therefore no insurance

 

[Mark Hickey]

If you work you get insurance.

Actually, if your place of employment offers insurance, you get the
opportunity to get insurance - usually with some sort of nominal
payment required on the employee's part. Many opt not to pay this and
to simply take their chances. The employees that do so show up as
"uninsured" in the statistics.

Mark Hickey
Habanero Cycles
http://www.habcycles.com
Home of the $795 ti frame

 

[Jeff Starr]

Actually, if your place of employment offers insurance, you get the
opportunity to get insurance - usually with some sort of nominal
payment required on the employee's part. Many opt not to pay this and
to simply take their chances. The employees that do so show up as
"uninsured" in the statistics.

Mark Hickey
Habanero Cycles
http://www.habcycles.com
Home of the $795 ti frame

"Nominal"? Apparently what you consider "nominal", others consider
the difference between insurance and other necessities.I don't have
exact numbers, but the amounts that I have heard, are extremely high.

The very poorest can often get medical assistance, the wealthy can get
the best of care. It is the lower middle class and the people on
Social Security, that can't afford health care. And they certainly
can't afford prescription drugs.

Just think, the money that we have spent on Iraq, could have been used
to give every person in this country medical care. If we are going to
plunge this country in to massive debt, it would have been nice to do
it for a good reason. We can't provide health care, but we can fund
unnecessary wars? That's just plain wrong. Unfortunately we can't undo
the damage that has been done, but hopefully, in the future, we can
elect people who will lead us in a better direction.


Jeff

 

[bigjim]

Just think, the money that we have spent on Iraq, could have been used
to give every person in this country medical care<<

So the unfit can keep breeding and not working. I work, my employer
pays insurance. Why should the government take care of people from the
cradle to the grave. We saw the "Gimme" mentality after Katrina when
all the animals who were unable to care for themselves blamed the gov't
for them not being prepared.

 

[Vic Vega]

"Nominal"? Apparently what you consider "nominal", others consider
the difference between insurance and other necessities.I don't have
exact numbers, but the amounts that I have heard, are extremely high.

The very poorest can often get medical assistance, the wealthy can get
the best of care. It is the lower middle class and the people on
Social Security, that can't afford health care. And they certainly
can't afford prescription drugs.

Just think, the money that we have spent on Iraq, could have been used
to give every person in this country medical care. If we are going to
plunge this country in to massive debt, it would have been nice to do
it for a good reason. We can't provide health care, but we can fund
unnecessary wars? That's just plain wrong. Unfortunately we can't undo
the damage that has been done, but hopefully, in the future, we can
elect people who will lead us in a better direction.


Jeff

Thank you for outing yourself as a flaming liberal.

 

[Carl 1 Lucky Texan]

"Nominal"? Apparently what you consider "nominal", others consider
the difference between insurance and other necessities.I don't have
exact numbers, but the amounts that I have heard, are extremely high.

The very poorest can often get medical assistance, the wealthy can get
the best of care. It is the lower middle class and the people on
Social Security, that can't afford health care. And they certainly
can't afford prescription drugs.

Just think, the money that we have spent on Iraq, could have been used
to give every person in this country medical care. If we are going to
plunge this country in to massive debt, it would have been nice to do
it for a good reason. We can't provide health care, but we can fund
unnecessary wars? That's just plain wrong. Unfortunately we can't undo
the damage that has been done, but hopefully, in the future, we can
elect people who will lead us in a better direction.


Jeff

Yeah, those pesky Iraqis need more mass child graves so some folks in
this country won't have to give up drinking, smoking, jet skis and SUVs
to pay for their own medical care.

you say >"give every person in this country medical care" < .Well, I
have read the Constitution and can find no right to health care. Oh, you
have a right to try to purchase health care. Or ask a charity to provide
it. But there are no 'rights' to health care, or jobs, or houses or
food. Those are called 'wishes'. And , guaranteeing them to you - would
create a slave of someone else.

We are in massive debt and were before the war, partly BECAUSE of
socialized programs. If i can get food from the gumint, and housing from
the gumint, and medical from the gumint - why should I work? I'm no big
fan of Bush - and have mixed feelings about our entry into the war - but
maybe, just maybe, the torture chambers will be quiet for a few years
and women will be able to drive and wear makeup and go to school.

Carl
1 Lucky Texan

 

[Jeff Starr]

Yeah, those pesky Iraqis need more mass child graves so some folks in
this country won't have to give up drinking, smoking, jet skis and SUVs
to pay for their own medical care.

Yup, you're right, that's the reason, all those old people who can't
afford the prescriptions they need, aren't getting them. It those
ever so popular jet skis. I sure didn't see too many poor people
leaving New Orleans on their jet skis, did you?

you say >"give every person in this country medical care" < .Well, I
have read the Constitution and can find no right to health care. Oh, you
have a right to try to purchase health care. Or ask a charity to provide
it. But there are no 'rights' to health care, or jobs, or houses or
food. Those are called 'wishes'. And , guaranteeing them to you - would
create a slave of someone else.

Medical care, wasn't very prevalent when the constitution was written.
Maybe our forefathers would have included it. Other countries have
socialized medicine and it isn't so they can all have jet skis. It's
because it makes sense.

We are in massive debt and were before the war, partly BECAUSE of
socialized programs.

The war has increased any debt that we had. So, it's ok to pile on the
debt for a war we shouldn't be fighting, but let's eliminate those
pesky socialized [what do you mean by this?] programs. What programs?

If i can get food from the gumint, and housing from
the gumint, and medical from the gumint - why should I work? I'm no big
fan of Bush - and have mixed feelings about our entry into the war - but
maybe, just maybe, the torture chambers will be quiet for a few years
and women will be able to drive and wear makeup and go to school.

I think you have your countries mixed up. In Iraq, I believe women
could drive and go to school. What you are describing is Afghanistan,
which made total sense to invade.

I'm certainly no fan of Saddam Hussein, but this war was a mistake. He
was no threat to America. I hate that people are being abused and
murdered in countries all over the world, but we can't be the world's
police. And how do we decide? How come, nobody wants to save all
those mutilated people in Africa?

Carl
1 Lucky Texan

Jeff

 

[Mark Hickey]

On Mon, 10 Oct 2005 22:37:26 GMT, Carl 1 Lucky Texan

The war has increased any debt that we had. So, it's ok to pile on the
debt for a war we shouldn't be fighting, but let's eliminate those
pesky socialized [what do you mean by this?] programs. What programs?

You libs really do avoid getting the facts when they contradict your
desired position, don't you? Social spending under Bush has
skyrocketed from the Clinton era - coming on DOUBLE what it was.

Yet you somehow believe Bush is snatching the God .... errr, god- ...
errrr, Clinton-given bread out of babies' mouths.

Mark Hickey
Habanero Cycles
http://www.habcycles.com
Home of the $795 ti frame

 

[Carl 1 Lucky Texan]

Yup, you're right, that's the reason, all those old people who can't
afford the prescriptions they need, aren't getting them. It those
ever so popular jet skis.

Well, it may very well be their CHILDREN who would rather have jet skis
than healthy parents. Americans in general are among the most medicated
and longest lived humans (hell - animals period) on earth. Is there some
poor soul suffering somewhere? Sure, and I'll chip in some money to help
them if the other several hundred folks reading this will match it. But
I think it's particularly harsh for the gumint to put guns to our heads
to force us to pay for someone elses health care - especially when there
is little control on whetehr that person's condition was self induced or
they wasted their own money instead of making any attempt to prepare for
the future. 'If you make the world fool proof - you will soon have a
world populated only by fools.'

I sure didn't see too many poor people

leaving New Orleans on their jet skis, did you?

Didn't see many leaving on gumint funded mass transit. Saw plenty
ignoring the very 'Big Brother' whose teat they've become addicted to,
when told to leave. Why is it folks want MORE gumint programs
immediately after a huge FAILURE of big gumint?

Medical care, wasn't very prevalent when the constitution was written.
??????????????

Maybe our forefathers would have included it. Other countries have
socialized medicine and it isn't so they can all have jet skis. It's
because it makes sense.

One of the beautiful things about this country, is it will allow folks
to leave. Please do not let me discourage you from emigrating to one of
several countries that presently offer socilaized health care. The
working slobs in those locations seem perfectly willing to put you on an
8 year waiting list for a knee joint.

The war has increased any debt that we had. So, it's ok to pile on the
debt for a war we shouldn't be fighting,

as I stated, we might have an area of some agreement here.
but let's eliminate those

pesky socialized [what do you mean by this?] programs. What programs?

OMG - there are just so many that need drastic reworking or elimination.
I'd start with social security and medicare - though other aspects
related to them in our economy would need to be changed along with them.
I tend to favor an incremental dismantling of them in general. I would
also like to begin doing away with the corporate welfare and gumint
proteced monopolies in our system.

I think you have your countries mixed up. In Iraq, I believe women
could drive and go to school. What you are describing is Afghanistan,
which made total sense to invade.

Sorry - yeah I guess Iraq was like Eden compared to Afghanistan, as long
as you weren't Kurdish.

I'm certainly no fan of Saddam Hussein, but this war was a mistake. He
was no threat to America. I hate that people are being abused and
murdered in countries all over the world, but we can't be the world's
police. And how do we decide? How come, nobody wants to save all
those mutilated people in Africa?

Again - I think we might agree somewhat here.

thanx - you can have the last word.

Carl

libertarians, the only group devoted to defending the rights of the
smallest minority on earth.....the Individual.

 

[tr2267]

Lots of people seem to confuse lack of health INSURANCE with lack of
access to health CARE. Between private charities, special programs of
pharmaceutical compnies, free private clinics, free public clinics,
county hospitals, 'mandatory' ER admittance, Medicaid, and assistance
from family and friends, Rare indeed is the individual that cannot get
medical care in the US if the want it. Does it happen? no doubt - but

It is very common. If you have a chronic health condition like many people in
the 50's and 60's and you do not have GROUP health insurance (decent individual
insurance would cost $3000.00/month) it is nearly impossible for middle class
people to get proper treatment. You can also get screwed very easily even if
you do have group insurance. The US health care system is totally fucked up by
the standards of the rest of the industrialized world and gets worse and worse
every year.


The New York Times <http://www.nytimes.com/>
------------------------------------------------------------------------
October 13, 2005
Being a Patient

Treated for Illness, Then Lost in Labyrinth of Bills

By KATIE HAFNER

When Bracha Klausner returned home after an extended hospital stay for a
ruptured intestine three years ago, she found stacks of mail from
doctors and hospitals waiting for her.

There were so many envelopes - some of them very thick - that at first,
Mrs. Klausner, 77, could not bring herself to open them, and she stored
them in large shopping bags in her Manhattan apartment.

When she finally did open some of the envelopes, there were pages filled
with dozens of carefully detailed items, each accompanied by a service
code: "Partial thrombo 2300214 102.00," "KUB Flat 2651040 466.00."

On the 15th page or so of each bill, a "balance forward" line listed
amounts in the tens of thousands of dollars. One totaled $77,858.04.

Another mailing, from her insurance company, clearly said, in large
type, "This is not a bill." But she could make no sense of the remark
codes: "G7 - Your benefit is based on the difference between Medicare's
allowable expense and the amount Medicare paid" or "QN - Your claim may
have been separated for processing purposes."

Mrs. Klausner's experience is shared by millions of Americans who,
frustrated and confused, find themselves devoting enormous amounts of
time and energy to sorting out their medical bills.

Walk into any drugstore, and the next few minutes of your life are
fairly predictable. After considering the choices, you make your
purchases and head for the cashier. Seconds after the transaction, you
are handed a receipt that reports to the penny what you paid for each
product, along with its brand, its size, and the date, time and location
of the purchase. But become a patient, and you enter a world of
paperwork so surreal that it belongs in one of Kafka's tales of the
triumph of faceless bureaucracies. And although some insurers and
hospitals are trying to streamline and simplify bills, the efforts have
been piecemeal.

Medical paperwork is a world of co-payments and co-insurers,
deductibles, exclusions and contracted fees. Nothing is as it seems:
patients receive statements that often do not reflect what is actually
owed; telephone calls to customer service agents are at best
time-consuming and at worst fruitless. The explanations of benefits that
insurers send out - known as E.O.B.'s - are filled with unintelligible
codes.

The system is so impenetrable that it mystifies even the most knowledgeable.

"I'm the president's senior adviser on health information technology,
and when I get an E.O.B. for my 4-year-old's care, I can't figure out
what happened, or what I'm supposed to do," said Dr. David Brailer,
National Coordinator for Health Information Technology, whose office is
in the Department of Health and Human Services. "I can't figure out what
care it was related to or who did what."

Dr. Blackford Middleton, a professor at Harvard Medical School with
special training in health services research, said he did not fare much
better than Dr. Brailer.

"I understand the words of diagnoses and procedures," he said. "But
codes? No. Or how things are paid or not paid? I don't understand that."

Dr. Brailer said he often used an analogy to describe the current state
of medical billing.

"Suppose you walk into a restaurant," he said, "and you don't get a
menu, you don't get any choice of what food you'll eat, they don't tell
you what it is when they're serving it to you, they don't tell you what
it's going to cost."

"Then, weeks or months later, you get a bill that tells you all the food
you ate and the drinks you had, some of which you remember and some you
don't, and although you get the bill, you still can't figure out what
you really owe," Dr. Brailer said.

Some people make valiant efforts to sort through bills and claims, but
end up throwing up their hands; others ignore them, until they are
pursued by collection agencies; still others, basically healthy but
weary at the prospect of a paperwork fusillade, stop going to the doctor
altogether.

Piles Upon Piles

In the days before managed care, most insurance plans operated on a
fee-for-service basis. Patients paid 20 percent of medical fees;
insurers paid 80 percent. But as health care costs have continued to
rise, many patients are being required to pay an ever-larger part of
their medical bills, and deductibles continue to increase. And to keep
the system churning, close to 30 cents of every dollar spent on health
care goes for administration, much of it spent generating bills and
explanations of benefits.

"The number of bureaucrats between the point of service and the final
cash reckoning is just incredible," said Dr. Thomas Delbanco, a
professor of primary care medicine at Harvard Medical School who is a
leader in the field of patient-centered care.

For many people, the piles of paperwork they must contend with reinforce
a simmering discontent with a system that aggravates tensions among
patients, hospitals, doctors and insurers.

Insurance companies are, by and large, unapologetic.

"Even though the amount of paperwork a patient has to deal with might
seem to be a lot, it would be much worse if there wasn't a unifying
organization like a health plan easing that burden," said Dr. Alan
Sokolow, chief medical officer at Empire Blue Cross Blue Shield in New York.

This might come as a surprise to Ellen Mayer, an artist who lives in
Chester, N.Y. Ms. Mayer, 54, has a rare type of gastrointestinal cancer
<http://topics.nytimes.com/top/news/...pics/cancer/index.html?inline=nyt-classifier>
that requires constant monitoring through blood work, CT scans and PET
scans.

The paperwork nightmare started for Ms. Mayer when her oncologist
switched hospitals. Everything suddenly seemed to need a justification,
or a new piece of paper with an authorization.

The stacks of papers, folders and Post-It notes related to Ms. Mayer's
treatment have started to take over her house. They fill manila
envelopes, boxes and files, which fill closets. They spill from the
dining room table onto chairs.

"You can't just be sick," she said. "You have to be sick and be drowning
in paperwork."

So overwhelming has the paperwork grown that Ms. Mayer has considered
giving up and ceasing all treatment because of the bureaucratic hassle
that accompanies it.

"It's comical, it's unbelievable," she said. "And I think to myself,
'What if I was an elderly person, or a single person? What if I wasn't
healthy enough to handle it?' "

Dr. Michael Mustille, associate executive director of the Permanente
Federation in Oakland, Calif., said medical paperwork often delivered "a
double psychological whammy."

"People get these things that look expensive that they can't
understand," Dr. Mustille said, "and then there's the worry that the
people they've paid for insurance may decline to assume responsibility
for it."

In Mrs. Klausner's case, her son bought her an elaborate paper
organizer, hoping it might help her face the chaos. She never used it.

Creditors began to call. Whenever a collection notice showed up, Mrs.
Klausner panicked and wrote a check or reached for the telephone to call
her son for help.

In the end, Medicare and United Healthcare paid most of Mrs. Klausner's
bills, which added up to more than $150,000. And although the unwelcome
mail has ceased, she cannot bring herself to throw out the bags filled
mostly with unopened envelopes dating back to 2002, as if doing so might
violate a law.

Dr. Middleton went through something similar with his elderly mother,
Dugan Middleton, a former nurse who died of thyroid cancer last February
at age 79.

Mrs. Middleton, who had lived alone in Palm Beach Gardens, Fla.,
preferred to handle the paperwork herself.

"It went on and on, with her reconciling her accounts with a lot of
different doctors," Dr. Middleton said.

He said that his mother wrote check after check and that "I'm sure she
was paying many of the same bills twice."

His medical credentials notwithstanding, Dr. Middleton was at a loss.
"It was ridiculously complex," he recalled.

Finally, in the last months of his mother's life, Dr. Middleton hired a
social worker who knew how to navigate the system to help with the bills.

How did things get this bad?

Most health care in the United States
<http://topics.nytimes.com/top/news/...ories/unitedstates/index.html?inline=nyt-geo>
is fragmented and profit-driven, a system in which everyone but the
patient is meant to benefit financially.

"Fragmentation is a fact of life in health care, and people consider
that to be one of the most fundamental problems," Dr. Brailer said. "We
pay by the piece. Everybody gets paid individually to do something: to
see a patient, to admit someone, to do a lab test, to do a prescription,
so health care is swamped by detailed, line-item bills."

After an office visit, a physician sends a diagnostic code to the
insurer, which then decides the level of payment. These codes differ
from the codes the insurer uses in the E.O.B.'s it sends to patients to
explain its decisions.

The billing codes used by hospitals are something else entirely.

"Each of them has their own system of paperwork, with their own billing
codes," said Ron Pollack, executive director of Families USA, a health
care advocacy group.

"Everyone is bogged down by this: the physicians, the hospitals, and
ultimately it reverberates to the consumer," Mr. Pollack said. "And to
the extent the consumer sees the bill, it's like reading hieroglyphics."

Mr. Pollack and other health care experts said they believed that only a
small percentage of people end up calling their insurance company to
inquire about a claim or to dispute a decision. Still fewer call a
hospital to go over a bill they believe might contain errors.

The Navigator

In late 2003, Bonnie MacKellar's son Elias, then nearly 2, stopped
eating. Then he stopped talking and walking. Elias had stage IV
neuroblastoma, a highly malignant tumor
<http://topics.nytimes.com/top/news/...pics/tumors/index.html?inline=nyt-classifier>
of the nervous system.

Though pushed to their emotional limits, Ms. MacKellar and her husband,
Thomas Dube, refused to buckle until the bills started to appear in the
mail each day: hospital bills amounting to tens of thousands of dollars;
invoices from doctors she did not remember meeting; E.O.B.'s from her
insurance company that explained nothing.

"It is hard to describe what it is like to be confronted with mounds of
scary claims and bills when you have a 2-year-old who is extremely ill,
who needs constant nursing and doesn't have a great chance of
surviving," Ms. MacKellar said. "And to sit in a hospital room, on hold
with the insurance company for 30 minutes or more only to have your
child start puking just as you get a rep on the line."

The E.O.B.'s seemed to serve little purpose beyond engendering fear.
They were detailed enough ("radiology services 2/19/04"), but when it
came to understanding the boxes listing the amounts charged, the amounts
not covered, the fees allowed, the available benefit and the remark code
(IT, 29, and the ever-mysterious QN ), Ms. MacKellar and her husband
were at a loss.

One statement that said, "Plan pays $00.00, patient pays $56,750.00,"
caused panic.

The remark code "07" stated, "These charges are for services provided
after this patient's coverage was canceled."

There had been no cancellation of coverage, but convincing the insurance
company of that fact was an ordeal.

The breaking point came when the group number on the health plan
changed, and Ms. MacKellar was unable to convince the insurance company
that it was billing under the wrong number.

In despair, she consulted a social services agency, which put her in
touch with Lin Osborn, a private consultant fluent in the arcane
language of health care billing. For a fee, Ms. MacKellar was told, Ms.
Osborn could take all the paperwork off her hands.

An expert in deciphering insurance and hospital billing codes, Ms.
Osborn spent several days straight working on the case and took care of
the entire mess, Ms. MacKellar said.

Still Searching

Although there is no single solution to the medical billing morass, Dr.
Brailer, of the Health and Human Services Department, said that the
increasing use of electronic records to enable insurers, physicians,
hospitals and pharmacies to share data would help.

And in some segments of the health care system, efforts are being made
to simplify and cut down on paperwork. Some insurance carriers, for
example, are reducing the number of E.O.B.'s they send out, posting them
online instead.

For the past 18 months, Blue Cross Blue Shield of North Carolina
<http://topics.nytimes.com/top/news/...ions/northcarolina/index.html?inline=nyt-geo>
has been working to reduce the total amount of paper it sends out.

"When there's no remaining financial liability, then we don't send the
E.O.B.'s," said Bob Greczyn, president of Blue Cross Blue Shield of
North Carolina.

Blue Cross Blue Shield of South Carolina
<http://topics.nytimes.com/top/news/...ions/southcarolina/index.html?inline=nyt-geo>
is offering physicians an electronic card reader that lets patients find
out how much they owe while they are still in the doctor's office.

In another effort to improve the system, the Patient Friendly Billing
Project, led by the Healthcare Financial Management Association, is
working with insurance companies on a long-term project to make bills
more comprehensible.

Still, Dr. Brailer said that, on the whole, "there isn't a lot under
way" in terms of efforts to fix the system.

Dr. Brailer pointed out that there had been frequent calls for a
standardized insurance billing form, which would sharply reduce
duplication and paperwork costs and "make patient management of these as
simple as online checking."

But, he said, "this has not gone beyond the wishful-thinking level
because the changeover would cost a lot."

Mitch Mayne, 38, is a marketing executive in San Francisco who considers
himself basically healthy.

Mr. Mayne went to his doctor three times between March and June for the
same thing: recurring bronchitis
<http://topics.nytimes.com/top/news/.../bronchitis/index.html?inline=nyt-classifier>.

Yet the explanation of benefits statements he received from his insurer
after each office visit differed drastically in the amount he owed,
varying from $10.66 to $90, with no explanation of the services provided.

"What did I do on June 27 that was different than what I did on April 6
that was different than what I did on March 4?" Mr. Mayne asked.

When he calls for an explanation of the E.O.B.'s, he said, the most
tangible result he sees is a new card in the mail with no indication of
the amount he owes as a co-payment printed on the card.

"I'm paying through the nose for this premium, and when I go to the
doctor it's a roll of the dice as to whether or not they'll pay it,"
said Mr. Mayne. "It seems like it depends on the mood of whoever happens
to be doing the claim that day, or on the phases of the moon."

Mr. Mayne recently grew so fed up that he decided to try to beat the
bronchitis on his own. "I can't deal with all this paperwork," he
recalled saying. "It's just too much of a hassle." That turned out to be
a mistake. Mr. Mayne became so sick that he finally relented and saw his
doctor.

What if something truly catastrophic should happen to the state of his
health?

"Oh wow, I hadn't even thought of that," Mr. Mayne said. "That's
actually a pretty scary proposition. If I can't manage my health care as
a healthy individual, the prospect of trying to manage it and be really
sick at the same time - I don't know that I could do it."